Advances in Therapy

, Volume 32, Issue 3, pp 187–200 | Cite as

Echinacea Reduces the Risk of Recurrent Respiratory Tract Infections and Complications: A Meta-Analysis of Randomized Controlled Trials

  • Andreas SchapowalEmail author
  • Peter Klein
  • Sebastian L. Johnston



Respiratory tract infections are common, and these infections occur frequently in children, susceptible adults, and older persons. The risk for recurrences and complications relates not only to the presence of viruses but also to immune function. Therefore, modulation of the immune system and antiviral interventions such as echinacea might reduce the risk of recurrences and possibly the development of complications.


MEDLINE, EMBASE, CAplus, BIOSIS, CABA, AGRICOLA, TOXCENTER, SCISEARCH, NAHL, and NAPRALERT were searched for clinical trials that studied recurrent respiratory infections and complications on treatment with echinacea extracts in a generally healthy population. Two independent reviewers selected randomized, placebo-controlled studies of high methodological quality and a Jadad score of ≥4. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated according to a fixed effect model.


Six clinical studies with a total of 2458 participants were included in the meta-analysis. Use of echinacea extracts was associated with reduced risk of recurrent respiratory infections (RR 0.649, 95% CI 0.545–0.774; P < 0.0001). Ethanolic extracts from echinacea appeared to provide superior effects over pressed juices, and increased dosing during acute episodes further enhanced these effects. Three independent studies found that in individuals with higher susceptibility, stress or a state of immunological weakness, echinacea halved the risk of recurrent respiratory infections (RR 0.501, 95% CI 0.380–0.661; P < 0.0001). Similar preventive effects were observed with virologically confirmed recurrent infections (RR 0.420, 95% CI 0.222–0.796; P = 0.005). Complications including pneumonia, otitis media/externa, and tonsillitis/pharyngitis were also less frequent with echinacea treatment (RR 0.503, 95% CI 0.384–0.658; P < 0.0001).


Evidence indicates that echinacea potently lowers the risk of recurrent respiratory infections and complications thereof. Immune modulatory, antiviral, and anti-inflammatory effects might contribute to the observed clinical benefits, which appear strongest in susceptible individuals.


Complications Echinacea Meta-analysis Recurrences Respiratory tract infections 



No funding or sponsorship was received for this study or publication of this article. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.

Conflict of interest

Andreas Schapowal and Peter Klein have no conflict of interest to declare. Sebastian Johnston received consulting fees from Bioforce, for review of this work; grants and personal fees from Centocor; grants and personal fees from Sanofi Pasteur; grants and personal fees from GSK; grants and personal fees from Chiesi; grants and personal fees from Boehringer Ingelheim; personal fees from Grünenthal; grants and personal fees from Novartis; grants, personal fees and shareholding from Synairgen, personal fees from Bioforce, outside the submitted work; In addition, Dr. Johnston has a patent Blair ED, Killington RA, Rowlands DJ, Clarke NJ, Johnston SL. Transgenic animal models of HRV with human ICAM-1 sequences. UK patent application No. 02 167 29.4, 18 July 2002 and International patent application No. PCT/EP2003/007939, 17 July 2003 licensed, a patent Wark PA, Johnston SL, Holgate ST, Davies DE. Anti-virus therapy for respiratory diseases. UK patent application No. GB 0405634.7, 12 March 2004 licensed, a patent Wark PA, Johnston SL, Holgate ST, Davies DE. Interferon-Beta for Anti-Virus Therapy for Respiratory Diseases. International Patent Application No. PCT/GB05/50031, 12 March 2004 licensed, a patent Wark PA, Johnston SL, Holgate ST, Davies DE. The use of Interferon Lambda for the treatment and prevention of virally induced exacerbation in asthma and chronic pulmonary obstructive disease. UK patent application No. 0518425.4, 9 September 2005 licensed, a patent Wark PA, Johnston SL, Holgate ST, Davies DE. Anti-Virus Therapy for Respiratory Diseases. US Patent Application—11/517,763, Patent No.7569216, National Phase of PCT/GB2005/050031, 04 August 2009 licensed, a patent Wark PA, Johnston SL, Holgate ST, Davies DE. Interferon-beta for Anti-Virus Therapy for Respiratory Diseases. European Patent Number 1734987, 5 May 2010 licensed, a patent Wark PA, Johnston SL, Holgate ST, Davies DE. Anti-Virus Therapy for Respiratory Diseases (IFNb therapy) Hong Kong Patent Number 1097181, 31 August 2010 licensed, a patent Wark PA, Johnston SL, Holgate ST, Davies DE. Anti-Virus Therapy for Respiratory Diseases (IFNb therapy). Japanese Patent Number 4807526, 26 August 2011 licensed, a patent Wark PA, Johnston SL, Holgate ST, Davies DE. Interferon-beta for Anti-Virus Therapy for Respiratory Diseases. New Hong Kong—Divisional Patent Application No. 11100187.0, 10 January 2011 licensed, and a patent Burdin N, Almond J, Lecouturieir, V, Girerd-Chambaz Y, Guy, B, Bartlett N, Walton R, McLean G, Glanville N, Johnston SL. Induction of cross-reactive cellular response against rhinovirus antigens European Patent Number 13305152, 4 April 2013 pending.

Compliance with ethics guidelines

The analysis in this article is based on previously conducted studies and does not involve any new studies of human or animal subjects performed by any of the authors.

Supplementary material

12325_2015_194_MOESM1_ESM.pdf (188 kb)
Supplementary material 1 (PDF 188 kb)


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Copyright information

© Springer Healthcare 2015

Authors and Affiliations

  • Andreas Schapowal
    • 1
    Email author
  • Peter Klein
    • 2
  • Sebastian L. Johnston
    • 3
    • 4
  1. 1.Allergy ClinicLandquartSwitzerland
  2. 2.d.s.h. Statistical Services GmbhRohrbachGermany
  3. 3.Airway Disease Infection Section, National Heart and Lung InstituteImperial College LondonLondonUK
  4. 4.MRC & Asthma UK Centre in Allergic Mechanisms of AsthmaImperial College LondonLondonUK

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